W. Va. Code R. § 85-20-60

Current through Register Vol. XLI, No. 24, June 14, 2024

Section 85-20-60 - Duration of payment for opioids to treat chronic, noncancer pain

60.1. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, will continue to pay for treatment with opioids if directly related to a compensable condition so long as the physician documents in addition to the information required in Section 58 of this Rule:

a. Substantial reduction of the patient's pain intensity; and

b. Continuing substantial improvement in the patient's function. Once the worker's condition has reached maximum medical improvement, further treatment with opioids is not payable. Opioid treatment for chronic, noncancer pain past the first three months of such treatment without documentation of substantial and progressive continuing improvement is presumed to be not proper and necessary.

W. Va. Code R. § 85-20-60